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� � ' 11T'IL.ITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.evere;twa.org <br /> ��v � �ni6�, <br /> PR�JECT ADDRESS <br /> ��„e G�-e-.��c,l ( �!�I c� 6 co I 1�.. t%cN,-� � 9�z C�1 <br /> Propedy O�vner Mail Address —� City � SlatelZip Phone <br /> �Lv G�6 ��yy <br /> Tenanl Name (If ihis is for a commercial business) <br /> Mo� P�.,...�,� I�r� f yr�sa s� ,�,s,-,.cc �,� 4s-z-S � K 2r'7c�3c� <br /> Contraclor Mail Address City State/Zip Phone <br /> r v�^ �T�A' �b'3Tv v S ?�0 3 S� <br /> WA State Contractor License Number(required) City of Everett 8usiness License Number(required) <br /> Wurk to be done: _,_ <br /> ❑ Side Sewer Repair , <br /> ❑ Side Sewer Aiteration <br /> ❑ Side Sewer— New Installation <br /> f�" Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> � �� .�� . <br /> ��� /� � -�p .� I S PERMIT# <br /> S�gnamre �a�e U I��- D2� <br /> aevi5eo nns¢oia <br />